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Abstract
Background and Objectives Previous studies have demonstrated the association between the procedure time (PT) and outcomes for patients with proximal large vessel occlusion; however, whether the relationship remains for patients with acute basilar artery occlusion (ABAO) was not clear. We aimed to characterize the association between PT and other procedure-related variables on clinical outcomes among patients with ABAO who underwent endovascular treatment (EVT).
Methods Patients with ABAO who underwent EVT with a documented PT in the EVT for Acute Basilar Artery Occlusion (BASILAR) study from January 2014 to May 2019 among 47 comprehensive centers in China were included. Multivariable analysis was performed to reveal the association between PT and 90-day modified Rankin Scale score, mortality, complications, and all-cause death at 1 year.
Results Of the 829 patients from the BASILAR registry, 633 eligible patients were included. Longer PT were associated with a lower rate of favorable outcome (by 30 minutes, adjusted OR 0.82 [95% CI 0.72–0.93], p = 0.01). In addition, a PT ≤ 75 minutes was associated with a favorable outcome (adjusted OR 2.03 [95% CI 1.26–3.28]). The risk of complications and mortality increased by 0.5% and 1.5% with every 10 minutes increase in PT, respectively (R2 = 0.64 and R2 = 0.68, p < 0.01). The cumulative rates of favorable outcomes and successful recanalization plateaued after 120 minutes (2 attempts). Restricted cubic spline regression analysis for the probability of favorable outcomes had an L-shape association (p nonlinearity = 0.01) with PT with significant benefit loss before 120 minutes and then appeared relatively flat.
Discussion For patients with ABAO, procedures that exceeded 75 minutes were associated with an increased risk of mortality and lower odds of a favorable outcome. A careful assessment of futility and the risks of continuing the procedure should be made after 120 minutes.
Glossary
- ABAO=
- acute basilar artery occlusion;
- ADAPT=
- A Direct-Aspiration First-Pass Technique;
- aOR=
- adjusted odds ratio;
- BASICS=
- Basilar Artery International Cooperation Study;
- BAOCHE=
- Basilar Artery Occlusion Chinese Endovascular trial;
- BASILAR=
- EVT for Acute Basilar Artery Occlusion Study;
- BEST=
- Basilar Artery Occlusion Endovascular Intervention versus Standard Medical Treatment trial;
- EVT=
- endovascular treatment;
- ICAS=
- intracranial artery stenosis;
- IQR=
- interquartile range;
- LVO=
- large vessel occlusion;
- mRS=
- modified Rankin Scale;
- NIHSS=
- National Institute of Health Stroke Scale;
- PC-ASPECTS=
- posterior circulation-Alberta Stroke Program Early scores;
- PT=
- procedure time;
- sICH=
- symptomatic intracerebral hemorrhage;
- SMT=
- standard medical therapy
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Editor-in-Chief José Merino, MD, MPhil, FAAN.
- Received August 15, 2022.
- Accepted in final form March 23, 2023.
- © 2023 American Academy of Neurology
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